Journal of neurosurgical anesthesiology
-
J Neurosurg Anesthesiol · Nov 2024
Intraoperative Burst Suppression by Analysis of Raw Electroencephalogram Postoperative Delirium in Older Adults Undergoing Spine Surgery: A Retrospective Cohort Study.
Postoperative delirium is a common complication in older adults, associated with poor outcomes, morbidity, mortality, and higher health care costs. Older age is a strong predictor of delirium. Intraoperative burst suppression on the electroencephalogram (EEG) has also been linked to postoperative delirium and poor neurocognitive outcomes. ⋯ Intraoperative burst suppression identified by visual analysis of the EEG was more strongly associated with delirium than age in older adults undergoing spine surgery. Further research is needed to determine the clinical importance of these findings.
-
J Neurosurg Anesthesiol · Nov 2024
Intraoperative Anesthetic Care During Emergent/Urgent Craniotomy or Craniectomy for Intracranial Hypertension or Herniation: A Systematic Review.
This systematic review aimed to identify and describe best practice for the intraoperative anesthetic management of patients undergoing emergent/urgent decompressive craniotomy or craniectomy for any indication. The PubMed, Scopus, EMBASE, and Cochrane databases were searched for articles related to urgent/emergent craniotomy/craniectomy for intracranial hypertension or brain herniation. Only articles focusing on intraoperative anesthetic management were included; those investigating surgical or intensive care unit management were excluded. ⋯ Three studies examined anesthetic technique (volatile vs. intravenous), 1 examined osmotic diuresis, 1 examined extubation in the operating room, 1 examined quality metrics, and 3 examined intracranial pressure and changes in vital sign. There was insufficient evidence to perform a meta-analysis. Overall, there was limited evidence regarding the anesthetic management of patients having urgent/emergent craniotomy or craniectomy for intracranial hypertension or herniation due to any cause.
-
J Neurosurg Anesthesiol · Nov 2024
Enhanced Recovery After Craniotomy: Global Practices, Challenges, and Perspectives.
The global demand for hospital care, driven by population growth and medical advances, emphasizes the importance of optimized resource management. Enhanced Recovery After Surgery (ERAS) protocols aim to expedite patient recovery and reduce health care costs without compromising patient safety or satisfaction. Its principles have been adopted in various surgical specialties but have not fully encompassed all areas of neurosurgery, including craniotomy. ⋯ Representatives from all 6 World Health Organization geographical world areas reported that barriers to the implementation of ERAS for craniotomy include the absence of standardized protocols, provider resistance to change, resource constraints, insufficient education, and research scarcity. This review emphasizes the necessity of tailored ERAS protocols for low and middle-income countries, addressing differences in available resources. Acknowledging limitations in subjectivity and article selection, this review provides a comprehensive overview of ERAS for craniotomy from a global perspective and underscores the need for adaptable ERAS protocols tailored to specific health care systems and countries.